Cirrhosis of the Liver (肝硬化 – Gānyìnghuà)

111. Cirrhosis of the liver (肝硬化 – gānyìnghuà)

Pattern differentiation Tongue signs Pulse Cause of disease1 Liver Spleen Signs Abdominal signs Body Coat Chinese medicine Enlarged liver Type of Enlarged Ascites Abdominal quality texture liver spleen signs distension pain Gathering Qì Binding Thin wiry Emotional depression Enlarged Slightly Dull Also No ascites Stomach duct patterns depression depression of white Liver qì not soothed level & soft or pain, often / rib-side liver qì Qì mechanism is smooth hard tightness, enlarged distension depressed and stagnated without & likes Phlegm Food slimy Wiry Spleen vacuity food tenderness to be Distention obstruction stagnation slippery stagnation, phlegm touched which may be phlegm damp internally painful obstruction generated, Phlegm stagnation mutually bound, qì Maybe dynamic inhibited initial Accumulation Qì Qì depression Maybe thin Wiry enduring depression and stage, just Distending patterns stagnation blood green- blood stagnation, starting to pain obstruction blue disharmony of vessels & see the networks, qì stagnation ascites & blood obstruction Qì vacuity Liver spleen Maybe Thin Wiry Enduring disease Stomach duct disharmony pale white or thin leading to qì vacuity, oppression Damp-heat white deep spleen and liver and obstruction slimy disharmony, damp-heat abdominal slippery obstruction distention Yáng Dampness Pale white Deep Enduring disease vacuity encumbering slimy thin leading to yang vacuity, May have a small

Functional spleen yang slippery slow dampness encumbering Qì depression spleen yang, qì amount of

Compensation phase phase Compensation blood depression blood ascites stagnation stagnation. Yīn Liver & kidney Red Yellow Wiry Enduring disease Abdominal vacuity yīn depletion slimy or fast leading to yīn vacuity, distention Vacuity heat scanty vacuity heat moving moving the blood blood Dual Qì & blood Dusky white Wiry Enduring disease May have vacuity dual vacuity red slimy thin leading to dual vacuity, a small Depressive slippery depressive bind & blood amount of bind blood obstruction ascites obstruction Blood Qì vacuity Stasis white Wiry Qì depression blood Severe hard Stabbing Will have Stomach duct stasis blood stasis purple slimy choppy obstruction, qì & blood enlargement pain a small & abdominal slippery thin mutually bound, amount bothersome Network vessel Stasis white Deep obstruction & stagnation ascites distension obstruction purple slimy wiry of the vessels and Blood stasis slippery choppy networks, stasis bind concretions turning to accumulation For all patterns: Appetite will be decreased and there will be nausea and vomiting.

1 Cause of disease – Western : Portal vein nature, Blood fluke nature, Necrosis, Bile nature - Hepatitis – chronic intestinal infection- alcoholic – nutritional deficiencies- blood fluke disease- serious disease toxic infection- serious internal (?) toxins- gallstones © Jason Blalack M.S., L.Ac. 12/02 – www.ChineseMedicineDoc.com

Pattern Psycho- Face Formal Taste Limb Fever Dry Thirst Jaundice Puffy Bleeding Spider Urine B.M. Formula Emotional body in temp. mouth with swelling nose & mole? mouth intake gums, of Liver fluid (??) Binding Emotional As usual As usual As As ------yellow Impaired Mu xiang shun depression depressed usual usual qi san of liver qì Food Slightly Neutral ------Constipated Liu mo tang stagnation tired phlegm obstruction Qì Heart As ------Impaired Da qi qi tang + depression vexation usual shi xiao san blood obstruction Liver spleen Fatigue & Yellow Slightly Bland Maybe - - - - + - + Maybe Occasionally Yin chen xiao disharmony lack of dark & thin lack of scanty loose yao san, yin Damp-heat strength gloomy warmth occasionally chen si ling san obstruction constipated + si ni san Dampness Spirit Sticky Lack - - - - + - + Short Unformed Yin chen fu shu encumbering fatigued and of yellowi tang spleen yang body is warmth Qì encumbered, depression fear of cold blood and lack of stagnation strength Liver & Vacuity Dark, Becoming Possibly Heat in - + + - - - + Yellow Constipation Yi guan jian kidney yīn vexation and malar emaciated Bitter the short depletion palpitations flush palms Vacuity heat and moving the soles blood Qì & blood Dizziness Dark Thin and Bland Lack - - - - + - + Frequent Unformed Ba zhen tang + dual vacuity and fatigue weak - of but xiao shi fan shi Depressive emaciated warmth scanty wan bind blood obstruction Qì vacuity Intense Dark Becoming bitter - - - - + - + Short red Binding Xiao yao san + blood stasis vexation emitting emaciated constipated Tao hong su wu easily a green- tang angered blue Bei jia jian wan + xiang sha liu jun zi tang Network - - - - + - + Short red Binding Xiao zheng jia vessel constipated (1) & (2) obstruction Blood stasis concretions

Formula name Pattern Medicinal ingredients Signs Herbs to add Mu xiang shun qi san Qì depression Mu xiang, qing pi, chen pi, gan cao, gui xin, Liver area pain + yuan hu, zhi ke, xiang fu, chuan xiong, zhi ke, chuan pu, wu yao, chuan lian xiang fu, cang zhu, tao ren Liu mo tang Phlegm obstruction Chen xiang, mu xiang, bing lang, wu yao, Belching - sha ren, bai zhu, + chuan zhi shi, da huang lian, yuan hu, yu jin Da qi qi tang + shi xiao san Qì depression blood Qing pi, chen pi, jie geng, huo xiang, gui Abdominal + mu xiang, zhi ke, sha ren, obstruction zhi, gan cao, san leng, e zhu, xiang fu, yi distention hou po, cang zhu, chen pi zhi, da huang, bing lang, pu huang, ling zhi Yin chen xiao yao san, Qi vacuity Dang gui, bai shao, chai hu, yu jin, dan Jaundice - dang shen, bai zhu shen, bai zhu, yin chen, nie jin, bie jia yin chen si ling san + si ni san Yin chen, fu ling, bai zhu, ze xie, zhu ling, Jaundice + yin chen, cang zhu, zhi zi, chai hu, shao yao, zhi shi, gan cao da huang, long dan cao Yin chen fu shu tang Yang vacuity Yin chen, fu zi, bai zhu, gan jiang, gan cao, Red, rough, + hua shi, che qian zi, zhen hu fu ling, ze xie inhibited urine lu Yi guan jian Yin vacuity Sha shen, mai men dong, dang gui, sheng Food stagnation + da fu pi, nei jin di, dan shen, chuan lian, jiao san xian, bie jia, sheng mu li Ba zhen tang + xiao shi fan shi Dual vacuity Dang shen, fu ling, bai zhu, gan cao, dang Nausea & + zhu ru, chen pi, ban xia, yu wan dui, bai shao, chi shao, shu di, chuan xiong, vomiting shu dan xiao shi, fan shi Xiao yao san + Tao hong su wu Qì vacuity blood tao ren, hong hua, dang gui, chi shao, chai Enlarged liver + dan shen, bie jia, san leng, tang stasis hu, yu jin, xiang fu e zhu

Bei jia jian wan + xiang sha liu Mu xiang, sha ren, dang shen, fu ling, bai jun zi tang zhu, gan cao, chen pi, ban xia, bie jia, zhe chong, di bie chong, li xiang chong, mu li, tao ren Xiao zheng jia (1) Blood stasis Dang gui, huang qi, san leng, e zhu, bie jia, Puffy swelling + fu ling, zhu ling, ze xie, che concretions chuan sha jia, dan shen, chen pi, jian qu, qian zi mai ya Xiao zheng jia (2) Dang gui, dang shen, yu jin, nei jin, san qi, Fatigue + huang qi, huang jing zhi zhe chong, pian jiang huang, zi he che

Pattern Differentiations Tongue signs Pulse Disease Cause of disease2 - Liver & spleen signs3 Digestive Body Coat type (?) Chinese medicine Enlarged liver Type of Food and Nausea Quality Texture liver pain drink & vomiting Repletion Qi Qi Contentious Slimy Wiry Ascites Insufficiency of central Early stages Early stages Distension, Inability Belching Distention vacuity stagnation binding of Water & rapid has stage yang, spleen loses its there is level and fullness, & to get ?? (实胀) phlegm qi strength healthy transportation, enlargement smooth and pain food obstruction qi is unable to slightly soft Without down Qi stagnation damp White slimy Wiry transform water, or solid – tenderness decreased obstruction deep sending it to the lower later stages Later stages Tenderness Yang Cold damp Spleen vacuity Distended Thin burner resulting in there is the and pain Obvious Maybe vacuity encumberin damp encumbrance water evil overflowing shrinkage condition is with Decrease nausea g spleen Cold damp Moderate hard, percussion in appetite encumbering granular Stabbing spleen with pain coming Yin Damp heat Damp heat brewing Cracked Yellow Wiry Water damp evil nodules in attacks Upflow vacuity brewing & red slimy &/or slippery becomes depressed & Complicated nausea with dark fast transforms to heat, by hepatitis grey (damp & heat) are or Heat distress blood Crimson Yellow wiry fast mutually steamed, progressive spillage slimy & gathering in the 3 natured liver necrosis that Heat clouding the Crimson with dark Wiry fast burners overflowing happens now pericardium grey into the skin and flesh and again Blood Liver Liver spleen blood Purple White Wiry has Enduring disease Clear signs of Severely with Maybe stasis spleen stasis stasis strength entering the network enlargement hard tenderness retching blood stasis Liver spleen stasis Purple Thin vessels leading to and pain counter- repletion crimson choppy blood stasis and with flow stasis or internal obstruction, percussion macules scallion channels & network vessels blocked Vacuity Yang Spleen Spleen yang Pale Deep thin Liver Original yang Later stages Hard Torpid Maybe patterns vacuity kidney yang vacuity weakness purple wiry kidney habitually depleted, having much surface intake have vacuity kidney yang weak synthesized enduring disease shrinkage presentation nausea vacuity weakness pattern overcoming yang, that is and kidney yang becomes granular or vomiting debilitated, opening & nodular closing lose their control, distilling (fx) is impaired Yin Liver Liver kidney yin Little Scanty or Wiry thin Final stage Yin is habitually Extremely vacuity kidney yin vacuity moisture- peeled slightly depleted, enduring decreased vacuity crimson rapid disease leads to yin Yin vacuity Wiry thin damage, blood vessels internal heat rapid are empty, & there is Yin desiccated coalescence of blood yang floating Liver kidney yin Completely Thin exhaustion peeled weak

2 Cause of disease -- Western : The series of sign and symptoms come about from decreased liver function and increased pressure in the portal vein 3 For all patterns the spleen can be seen to have a slight to medium degree of enlargement

Pattern Pyscho-Emotional Face Formal Taste in Limb Bowels Formula body mouth temp. Fever Dry mouth Thirst with intake of fluid Jaundice Puffy swelling Bleeding Nose / gums Spider mole? Liver Palms Urination Contentious Suddenly have uneven As usual Robust Bland Maybe - - - + - - - - Slightly Slightly hard Shi zao wan, zhou (?) binding of breathing and unable to no hard to to solve che wan, kong xian dan Water & qi prostrate warmth solve ? lu shi shen yan wan Qi stagnation Dizziness with lack of Dull & Slightly Bland ------Short & Slightly Chai hu shu gan san + damp strength stagnant thin rough sloppy ping wei san, wei ling obstruction san Spleen Dizziness, fatigued, lack of Yellow dark Emaciated Bland No - - - - + - - - scanty Sloppy Si jun zi tang + si ling vacuity damp strength & gloomy warmth san encumbrance

Cold damp Fatigue of essence-spirit, Sticky Cold + - - + + + + - Shi pi yin encumbering fear of (temerity?) cold (怯 spleen 寒), laziness to move (揽东) Damp heat Vacuity vexation with 黄暗血缕 Emaciated Oppressively Heat in + - - + + ++ + - Red, Constipated Zhong man fen xiao brewing palpitations 红痣 hot, bitter the rough, & or sloppy wan, zhou(?) che wan, yellow-dark taste, & dry heart of scanty grimy yin chen si ling san Heat distress Suddenly large quantities ____ the + - - + + + + - Large ??? jiao di huang tang blood spillage of vomiting blood and reddish palms amounts of blood in the stools (下血) mole and blood soles Heat clouding Spirit in a stupor (神识昏 ------++ - Constipated An gong niu huang the 迷)?? or grimy wan, zhi bao dan pericardium sloppy

Liver spleen Body fatigue , lack of Dark black, Passable (?) Possible maybe - + - - - - ++ - Short and Yellow color Zhou che wan blood stasis strength of, vexation and many times （尚可） bitter taste no red Severe propensity to anger blood warmth 剧易怒 tinged Liver spleen ( ) Emaciated No - - - - + - + + Tiao ying yin, ge xia brown lips stasis warmth zhu yu tang repletion Spleen yang Spirit fatigue, shortness of Greenish- Emaciated Bland No - - - - + - + + Clear Sloppy Fu zi li zhong tang + wu vacuity breath, laziness to talk yellow warmth white, ling san, fu zi li ling weakness short, tang kidney yang Spirit fatigue, body is cold, ______? cold - - - - + - + + scanty, & Ji sheng shen qi tang + vacuity hips and legs are sore and white , dark difficult ? fu zi li zhong tang weakness weak black Liver kidney A lack of nutrition and Dark, Emaciation, Little fluids Vexing - + - - - + + + Short and Maybe Liu wei di huang tang + yin vacuity anemia is shown gloomy (匙状甲) or maybe heat in scanty constipated si ling san Yin vacuity (??):Vacuity vexation with stagnant , skin rough bitter taste the five + + + - - + + + Mai wei di huang tang internal heat palpitations, many times green-blue, hearts they develop a type (?) of purple, or Yin - + - - - + + + San jia di huang tang neuritis, or angular malar flush desiccated stomatitis yang floating

Formula Name Pattern Medicinal Ingredients Shi zao wan Water qi contending-bind (?) Da zao, gan sui, da ji, yan hua (IF there is high fever, heart disease, or ulcerating sores (??) emitting blood this Rx is prohibited) [Note: same for the following 3 Rx.’s] zhou (?) che wan Da huang, gan sui, da ji, qian niu zi, shang lu, da fu pi zi, chen xiang, yu li ren, hu po, xi ??? kong xian dan Bai jie zi, gan sui, da ji lu shi shen yan wan Er chou, (sheng) jiang zhi, da zao, hong tang (sugar)

Chai hu shu gan san + ping wei Qi stagnation damp obstruction Cang zhu, hou po,chen pi, gan cao, chai hu, chi shao, chuan xiong, xiang fu, zhi ke, mu xiang, sha ren, fu ling, bai zhu san wei ling san Cang zhu, hou po, chen pi, ze xie, xiang fu, (da) fu pi ?, che qian zi, dong gua pi, mao gen

Si jun zi tang + si ling san Spleen vacuity damp Dang shen, fu ling, bai zhu, ze xie, zhu ling, che qian zi encumbrance Shi pi yin Cold damp encumbering spleen Fu zi, gan jiang, gan cao, fu ling, bai zhu, hou po, huo xiang, cao guo, mu gua, da fu zi, sheng jiang, da zao

Zhong man fen xiao wan Damp heat brewing Dang shen, fu ling, bai zhu, gan cao, ban xia, chen pi, huang qin, hou po, zhi shi, sha ren, jiang huang, zhi mu, ze xie, gan jiang

zhou(?) che wan, Da huang, gan sui, da ji qian niu zi, (Only use Offensive precipitation temporarily to reduce edema, but precipitation is the correct Tx) yin chen si ling san Yin chen, zhi zi, huang bai, fu ling, zhu ling, ze xie, hou po, huang lian

xi jiao di huang tang Heat distress blood spillage Xi jiao, sheng di, chi shao, mud an pi An gong niu huang wan Heat clouding the pericardium Niu huang, xi jiao, zhu sha, ____ ? xiang, mei pian, zhen zhu, xiong huang, shan zhi, huang qin, huang lian, yu jin, jin bo (gold leaf) is placenta ?? (金箔为衣),? zhi bao dan Niu huang, xi jiao, zhu sha, ____ ? xiang, dai nao, hu po, xiong huang, an xi xiang, jin yin gen

Zhou che wan Liver spleen blood stasis Da huang, gan sui, da ji, qian niu zi ( Tiao ying yin, Liver spleen stasis repletion Dang gui, chi shao, bai shao, chuan xiong, yuan hu (?), da huang, bing lang, chi fu ling, chen pi, e zhu, qu mai, xi xin, rou gui, gan cao, sang (bai) pi, fu pi, ting ling zi ge xia zhu yu tang Tao ren, hong hua, dang gui, chi shao, dan shen, san leng, e zhu, xiang fu, zhi ke Fu zi li zhong tang + wu ling Spleen yang vacuity weakness Fu zi, gan jiang, dang shen, bai zhu, fu ling, zhu ling, ze xie, che qian zi, huang qi san fu zi li ling tang Fu zi, gan jiang, gui zhi, fu ling pi, jiao bai zhu, hou po, ze xie, da fu pi

Ji sheng shen qi tang kidney yang vacuity weakness Shu di, shan zhu yu, fu ling, mud an pi, ze xie, fu zi, rou gui, niu xi, che qian zi, ba ji tian, hu lu ba, lu jiao, zi he che fu zi li zhong tang Fu zi, gan jiang, dang shen, bai zhu, gan cao Liu wei di huang tang + si ling Liver kidney yin vacuity Shu di, shan zhu yu, shan yao, fu ling, mu dan pi, ze xie, bai zhu, dang gui, zhu ling, bai shao, niu xi, che qian zi, qi guo, he shou san wu Mai wei di huang tang Yin vacuity internal heat Shu di, shan zhu yu, shan yao, fu ling, mu dan pi, ze xie, bai zhu, dang gui, zhu ling, bai shao, mai men dong, wu wei zi, yuan shen

San jia di huang tang Yin desiccated yang floating Shu di, shan zhu yu, shan yao, fu ling, mu dan pi, ze xie, gui ban, bie jia, mu li San jia di huang tang Liver kidney yin exhaustion Shu di, shan zhu yu, shan yao, fu ling, mu dan pi, ze xie, gui ban, bie jia, mu li, nu zhen zi, han lian cao

Remarks Sign Medicinals to add or subtract Scanty urination + che qian zi, ze xie, zhu ling, bing lang, hua shi, ting li zi Loose Stools (?) Sloppy? - dang gui, chai hu; + bai bian dou, shan yao, chao gu ya (?), mai ya, dang shen Constipation + da huang Nausea & Vomiting + chen pi, ban xia Spitting upflow of clear fluids (?) + ban xia, gan jiang Tongue fur is greasy & white + cang zhu Thirsty + xuan shen, mai men dong, shi hu Slight fever + yin chai hu, qing hao, di gu pi Nose & teeth emitting blood (?) + sheng di, mao gen, mud an pi, shi hu, xian he cao, zhi bie jia - tao ren, hong hua, san leng, e zhu Ascites + chuan jiao mu, hu lu ba, ma bian cao, che qian zi, dong gua pi Ascites with severe blue veins revealed on the abdomen + ma bian cao, shui hong hua zi Liver & spleen enlarged + bie jia, mu li, san leng, e zhu, yu jin, tao ren, hong hua, (double the dose of dan shen)? Liver & spleen enlarged and hard + bie jia, mu li Distorted engorgement of the esophageal veins which have ruptured and are emitting blood (?) + han lian cao, xian he cao The basic Formula for treating Cirrhosis of the Liver is : xia yu xue tang – dan shen, dang gui, dang shen, huang qi, sheng di, tao ren, zhi da huang, shan jia, bie jia, di bie chong Signs: Medicinals to add Blood plasma albumin levels are reduced, ascites, and many times a one-sided thick tongue fur Bai zhu, tai zi shen, huang qi, (double dose?), yu jin, zhi shi, xiang fu Liver cell necrosis, liver yin internal damage (?), Excessive urination, Tongue is dry red lightly Bie jia, (double dose), shi hu, mai men dong (?) peeled Liver function damaged Mu dan pi,

i Translator believes this should be short & clear.